Citation Nr: 0125254
Decision Date: 10/25/01 Archive Date: 10/29/01
DOCKET NO. 99-24 676 ) DATE
)
)
On appeal from the
Department of Veterans Affairs (VA) Regional Office (RO)
in Fargo, North Dakota
THE ISSUES
1. Entitlement to service connection for a right knee
disability.
2. Entitlement to service connection for a right ankle
disability.
3. Entitlement to service connection for a gastrointestinal
disorder.
REPRESENTATION
Appellant represented by: The American Legion
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
W. Yates, Counsel
INTRODUCTION
The veteran served on active duty from December 1965 to
September 1969.
This case comes to the Board of Veterans' Appeals (Board)
from a July 1999 RO decision which denied service connection
for right knee and right ankle disorders (including
arthritis) and for a gastrointestinal disorder (including
diarrhea). A personal hearing was held before an RO hearing
officer in December 1999. In June 2001, a hearing was held
before a member of the Board sitting at the RO (Travel Board
hearing).
The Board notes the claims for service connection were
previously denied by the RO in May 1974 for the reason of
failure to report for VA examination. The current claims are
considered new claims and will be reviewed on a de novo
basis.
REMAND
The veteran served on active duty in the Navy from December
1965 to September 1969. His service medical records show
that at an October 1965 enlistment examination, he gave a
history of mild hemorrhoids and leg cramps; examination
findings including flat feet and a 4 inch scar on the lower
right leg. He was seen aboard ship in November 1967 for
right knee symptoms; he gave a several year history of
intermittent pain of the knee, and he gave a history of a
knee injury with swelling at age 12. The provisional
diagnosis was possible internal derangement of the right
knee. He was referred by his ship's medical department to
the orthopedic clinic at Oakland Naval Hospital for further
evaluation of the right knee problem; when seen at the
hospital orthopedic clinic in December 1967, the impression
was chronic strain of the insersion of the lateral hamstring
tendon, and conservative treatment was provided. Service
medical records do not otherwise refer to specific right
knee, right ankle, or gastrointestinal disorders. The
September 1969 service separation examination noted the scar
on the lower right leg; and no right knee, right ankle, or
gastorintestinal disorder was noted on clinical evaluation.
The veteran was seen for gastointestinal problems in August
1970 by R. L. Odegard, M.D. (according to a January 1974
letter from this doctor). The veteran reported on his
initial compensation claim that shortly after service, from
about 1969 to 1971, he was treated for various
gastointestinal problems at the Air Force Base Hospital in
Minot, North Dakota. However, records of this treatment have
not been obtained. It appears that the Minot Air Force Base
Hospital had an arrangement with the VA to treat veterans. A
summary of a February 1974 admission to the Minot Air Force
Base Hospital shows the veteran then underwent surgical
removal of a soft tissue mass (ganglion) of the right ankle;
a notation on the document indicates the veteran was a VA
beneficiary. As to the right knee, the first post-service
medical evidence now available is a May 1975 treatment record
from Dr. Peterson (the record also notes right ankle
problems).
A number of later post-service medial records describe right
knee, right ankle, and gastrointestinal disorders. The
veteran has had multiple operations on his right knee, which
now has arthitis; he now has right ankle arthritis; and
various gastrointestinal problems (including Helicobacter
pylori infection) have been diagnosed over the years.
In a December 1999 letter, Brian Gale, DPM (podiatrist)
opined that the veteran's right knee and ankle problems were
due to a purported service injury. In a January 2000 letter,
Tim Luithle, M.D., stated that the veteran's stomach problem
involved Helicobacter pylori which may have been present with
the first episodes of gastritis years ago.
Under the circumstances of this case, there is a further VA
duty to assist the veteran in developing evidence pertinent
to his claim. 38 U.S.C.A. § 5103A (West Supp. 2001)
(Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475,
114 Stat. 2096 (2000)); 66 Fed.Reg. 46,620, 46,630 (Aug. 29,
2001) (to be codified as amended at 38 C.F.R. § 3.159). An
effort should be made to obtain any additional post-service
medical records, particularly any records of the veteran's
treatment at Minot Air Force Base Hospital during the years
immediately after service. VA examinations with opinions on
the etiology of the claimed disorders are also warranted.
Accordingly, this case is REMANDED for the following:
1. The RO should obtain copies of all
records of the veteran's treatment, as a
civilian VA beneficiary, at Minot Air
Force Base Hospital from September 1969
to the present. The RO should check with
both VA and service department sources
which might have these records, since the
file indicates that Minot Air Force Base
Hospital was once used by the VA to treat
veterans (it is unknown to the Board
whether such is still the case). If
records of treatment of veterans for the
VA at this military facility are no
longer available, the RO should explain
why.
2. The RO should also give the veteran
an opportunity to identify (names,
locations, dates) all other medical
providers who treated him since service
for right knee, right ankle, and
gastrointestinal problems. The RO should
then obtain copies of the related medical
records which are not already on file.
3. The RO should have the veteran
undergo a VA orthopedic examination on
the nature and etiology of his right knee
and right ankle disorders, and a VA
gastrointestinal examination on the
nature and etiology of his
gastrointestinal conditions. The claims
folder should be provided to and reviewed
by the doctors in conjunction with the
examinations, and the examination reports
should note that such has been
accomplished. All current right knee,
right ankle, and gastrointestinal
disorders should be diagnosed. Based on
examination findings, review of
historical records, and medical
principles, the VA orthopedic doctor
should provide a medical opinion, with
full rationale, as to date of onset and
etiology of the veteran's current right
knee and right ankle disorders; the VA
gastrointestinal examiner should do
likewise as to the veteran's current
gastrointestinal disorders.
4. After the above action is completed,
the RO should review the claims for
service connection for right knee, right
ankle, and gastrointestinal disorders. If
the claims are denied, the veteran and his
representative should be provided a
supplemental statement of the case, and
given an opportunity to respond, before
the case is returned to the Board.
The appellant has the right to submit additional evidence and
argument on the matters the Board has remanded to the RO.
Kutscherousky v. West, 12 Vet. App. 369 (1999).
L.W. TOBIN
Member, Board of Veterans' Appeals
Under 38 U.S.C.A. § 7252 (West 1991 & Supp. 2001), only a
decision of the Board of Veterans' Appeals is appealable to
the United States Court of Appeals for Veterans Claims. This
remand is in the nature of a preliminary order and does not
constitute a decision of the Board on the merits of your
appeal. 38 C.F.R. § 20.1100(b) (2001).